Tolerance for bullying behavior is way down

Take, for example, this article by Sandra Boodman in the Washington Post:

At a critical point in a complex abdominal operation, a surgeon was handed a device that didn’t work because it had been loaded incorrectly by a surgical technician. Furious that she couldn’t use it, the surgeon slammed it down, accidentally breaking the technician’s finger. “I felt pushed beyond my limits,” recalled the surgeon, who was suspended for two weeks and told to attend an anger management course for doctors.

The 2011 incident illuminates a long-festering problem that many hospitals have been reluctant to address: disruptive and often angry behavior by doctors. Experts estimate that 3 to 5 percent of physicians engage in such behavior, berating nurses who call them in the middle of the night about a patient, flinging scalpels at trainees who aren’t moving fast enough, demeaning co-workers they consider incompetent or cutting off patients who ask a lot of questions.

“We’re talking about a very small number of physicians, but the ripple effect is profound,” said Charles Samenow, an assistant professor of psychiatry at George Washington University School of Medicine, who evaluates doctors with behavioral problems.

For generations, bad behavior by doctors has been explained away as an inevitable product of stress or tacitly accepted by administrators reluctant to take action and risk alienating the medical staff, particularly if the offending doctors generate a lot of revenue. Recently at one Virginia hospital, according to University of Virginia School of Nursing dean Dorrie Fontaine, a veteran operating-room nurse with 30 years’ experience walked into her supervisor’s office and quit after a surgeon screamed at her — his usual reaction to unwelcome news — when she told him that a routine count revealed that an instrument was missing. Hospital administrators shrugged off the episode, saying, “Well, that’s the way he is.”

But that time-honored tolerance is waning, Samenow and other experts say, as a result of regulations imposed in 2009 by the Joint Commission, the group that accredits hospitals. These rules require hospitals to institute procedures for dealing with disruptive behavior, which can take passive forms such as refusing to answer pages or attend meetings. The commission has called for a “zero tolerance” approach. Such behavior is not unique to doctors; researchers have found that nurses act out, too, mostly to other nurses, but that their behavior is less likely to affect patients.

Growing attention to the problem, which appears to be most common among surgeons and other specialists who do procedures, has spawned a cottage industry of therapists who provide anger management counseling, which is sometimes billed as “executive coaching.” Programs are flourishing at Vanderbilt, the University of Virginia, the University of California at San Diego and, most recently, GWU.

Most doctors who enroll are middle-aged men sent by hospitals or state medical boards that have ordered them to shape up. . .

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